Giant hiatal hernia (GHH) with intrathoracic stomach is a rare condition. It is a type 3 or mixed hernia (with sliding and paraesophageal component) with more than 30% of the stomach protruding into the chest cavity. These hernias are usually associated with gastric rotation, mostly with organoaxial twist. They have nonspecific clinical manifestations, which include vomiting, and chest or epigastric pain. Complications such as volvulus, perforation, or gastric obstruction constitute a medical emergency. In many cases, these hernias can be detected incidentally on a chest radiograph. Imaging studies, mainly multidetector CT and upper gastro-intestinal series represent vital tools for diagnosis and anatomical characterization of these lesions. The treatment of GHH requires an open or laparoscopic surgical approach. We report the case of a patient evaluated in our department who was diagnosed with giant hiatal hernia with intrathoracic stomach and organoaxial gastric rotation.
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